title: Full-length radiographs of the femur in patients with a femoral neck fracture and co-existent malignancy--are they of benefit?
abstract: It is recommended that full-length femoral radiographs should be obtained in patients presenting with a femoral neck fracture and a co-existent history of malignancy. Over a two-year period, we identified 133 (47 males, 86 females) patients admitted with a femoral neck fracture and a co-existent history of malignant disease, representing 6.5% of all femoral neck fractures admitted within this time frame. None of the patients had previously diagnosed bone metastases. The mean patient age was 80 years (range, 30-97 years). In 114 cases the fracture was traumatic in origin, most commonly a simple fall (86%). In 19 cases the fracture was atraumatic with histopathological analysis demonstrating the presence of bony metastases. Overall, breast (35%), lower gastrointestinal (22%), prostatic (18%) and bronchogenic carcinomas (7%) were the most common associated malignancies. On reviewing the full-length anteroposterior and lateral femoral radiographs, none of the patients had demonstrable pathology in the remainder of the femur. Furthermore, none of the patients to date have required readmission with a secondary fracture relating to disease in the middle or distal thirds of their femur. We conclude that full-length views of the femur are of limited value in patients presenting with a femoral neck fracture and a co-existent history of malignant disease.
authors.affiliation: Department of Orthopaedics and Trauma, Royal Victoria Hospital, Grosvenor Road, Belfast. mof@doctors.org.uk
authors.forename: Maurice T
authors.initials: MT
authors.lastname: O'Flaherty
authors.forename: Neville W
authors.initials: NW
authors.lastname: Thompson
authors.forename: Peter K
authors.initials: PK
authors.lastname: Ellis
authors.forename: R John
authors.initials: RJ
authors.lastname: Barr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology